Assessment of Diagnostic Value of Procalcitonin and/or (1,3)-β-D-glucan Test for Pulmonary Infection_West China Medical Journal

Authors：

 LUXian-lei ¹ , LUOYu-peng ¹ , CAOZhi-yue ¹ , YANGJin ¹ , ZHUWen-lei ¹ , WANGPing ² , LIUBo ³ , ZHUYong ⁴

1. Clinical Laboratory, the Fifth People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;
2. Intensive Care Unit, the Fifth People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;
3. Department of Respiratory Medicine, the Fifth People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;
4. Department of Rheumatism and Hematology;the Fifth People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;

Corresponding?author：

Keywords：

Procalcitonin; (1,3)-β-D-glucan; Pulmonary; Infection

DOI：

10.7507/1002-0179.20150069

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To assess the diagnostic value of procalcitonin (PCT) and/or (1,3)-β-D-glucan test (serum BG assay) for pulmonary infection. Methods We collected 1 027 cases randomly from January 24th, 2013 to January 25th, 2014. First, we accumulated isolates from these cases in sputum culture. Second, we compared PCT and sputum culture, serum BG assay and sputum culture, CT and serum BG assay. Then we accumulated these PCT and studied its distribution when PCT>0.5 ng/mL and when their sputum culture was positive. We also accumulated these serum BG assay results and studied its distribution when their sputum culture was positive for aspergillus or suggested aspergillus infection by CT. Finally, we estimated the significance of the combined use of PCT and serum BG assay for diagnosis of pulmonary infection. Results In these cases, pathogens were mainly multiple drug-resistant organisms and tuberculosis, or fungi. We found that PCT value presented a skew distribution in disease with a median of 2.06 ng/mL. Single PCT or combination of PCT and sputum culture had similar distribution. With sputum culture as the reference, PCT sensitivity was 41.2% and specificity was 66.4%. In the cases of sputum culture aspergillus and CT suggestion of aspergillus infection, serum BG assay value distribution was similar, and the median and average were both lower than cut-off. With sputum culture as the reference, serum BG assay sensitivity was 13.2% and specificity was 84.1%. In the 12 cases with positive sputum culture and serum BG assay, serum BG assay median was 112.91 pg/mL. With CT as the reference, serum BG assay sensitivity was 21.4% and specificity was 75.0%. In the 17 cases with the same sputum and blood culture result with the PCT median of 7.51 pg/mL, there were three cases whose PCT value was under the cutoff and three cases whose serum BG assay value was above the cutoff. In evaluation of the combination of PCT and serum BG assay, the analysis had yielded that we could neither diagnose pulmonary infection with both being positive, nor exclude the disease with both being negative. Conclusion With regard to PCT and serum BG assay, we should be prudent and wise and use it after reasonable evaluation and entire analysis.

Citation： LUXian-lei, LUOYu-peng, CAOZhi-yue, YANGJin, ZHUWen-lei, WANGPing, LIUBo, ZHUYong. Assessment of Diagnostic Value of Procalcitonin and/or (1,3)-β-D-glucan Test for Pulmonary Infection. West China Medical Journal, 2015, 30(2): 222-226. doi: 10.7507/1002-0179.20150069 Copy

1.	Christ-Crain M, Jaccard-Stolz D, Bingisser R. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blinded interventiontrial[J]. Lancet, 2004, 363(9409):600-607.
2.	常春. 降鈣素原在呼吸系統疾病中的應用[J]. 中華現代內科學雜志, 2006, 3(6):656-658.
3.	謝永平, 黎國梅, 溫杰冉等. 血漿(1, 3)-β-D葡聚糖檢測在肺部真菌感染療效評價中的作用[J]. 國際檢驗醫學雜志, 2014, 35(5):517-518.
4.	Onishi A, Sugiyama D, Kogata Y. Diagnostic accuracy of serum 1,3-β-D-Glucan for pneumocystis jiroveci pneumonia, invasive candidiasis, and invasive aspergillosis:systematic review and meta-analysis[J]. J Clin Microbiol, 2012, 50(1):7-15.
5.	汪明明, 崔速南, 張景遙, 等. 血清降鈣素原測定在感染性疾病中的診斷意義[J]. 中國抗感染化療雜志, 2002, 2(4):215-217.
6.	高航, 王君蘭, 錢翠, 等. 血漿(1, 3)-β-D葡聚糖檢測對慢性阻塞性肺疾病并發肺部真菌感染的研究[J]. 中華醫院感染學雜志, 2012, 22(21):4690-4692.
7.	謝永平, 黎國梅, 溫杰冉, 等. 血漿(1,3)-β-D葡聚糖檢測在肺部真菌感染療效評價中的作用[J]. 國際檢驗醫學雜志, 2014, 35(5):517-518.
8.	中國侵襲性真菌感染工作組. 血液病/惡性腫瘤患者侵襲性真菌感染的診斷標準與治療原則(第三次修訂)[J]. 中華內科學雜志, 2010, 49(5):451-454.
9.	高蕾, 周新. (1, 3)-β-D 葡聚糖檢測在侵襲性真菌感染中的診斷意義[J]. 中國感染與化療雜志, 2008, 8(2):123-125.
10.	Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis[J]. Mater Sociomed, 2013, 25(4):277-281.
11.	楊蘭萍, 胡皖玲, 余小龍. 血清降鈣素原指導兒童呼吸道感染抗生素應用的臨床意義[J]. 中國醫學工程, 2014, 22(1):40-42.
12.	常秀娟, 王春平, 曾珍, 等. 血清降鈣素原水平對發熱患者的診斷價值研究[J]. 人民軍醫, 2014, 57(3):281-282.
13.	張志華, 潘航, 沈紅石, 等. 降鈣素原和超敏C反應蛋白檢測在再生障礙性貧血合并肺部感染患者病原菌診斷中的意義[J]. 國際檢驗醫學雜志, 2013, 34(23):3146-3148.
14.	梅春霞, 劉娟, 徐智. APACHEⅡ評分和降鈣素原對肺部感染預后的預測作用[J]. 第三軍醫大學學報, 2014, 36(8):802-805.
15.	Dou YH, Du JK, Liu HL, et al. The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis[J]. Diagn Microbiol Infect Dis, 2013, 76(4):464-469.

1. Christ-Crain M, Jaccard-Stolz D, Bingisser R. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blinded interventiontrial[J]. Lancet, 2004, 363(9409):600-607.
2. 常春. 降鈣素原在呼吸系統疾病中的應用[J]. 中華現代內科學雜志, 2006, 3(6):656-658.
3. 謝永平, 黎國梅, 溫杰冉等. 血漿(1, 3)-β-D葡聚糖檢測在肺部真菌感染療效評價中的作用[J]. 國際檢驗醫學雜志, 2014, 35(5):517-518.
4. Onishi A, Sugiyama D, Kogata Y. Diagnostic accuracy of serum 1,3-β-D-Glucan for pneumocystis jiroveci pneumonia, invasive candidiasis, and invasive aspergillosis:systematic review and meta-analysis[J]. J Clin Microbiol, 2012, 50(1):7-15.
5. 汪明明, 崔速南, 張景遙, 等. 血清降鈣素原測定在感染性疾病中的診斷意義[J]. 中國抗感染化療雜志, 2002, 2(4):215-217.
6. 高航, 王君蘭, 錢翠, 等. 血漿(1, 3)-β-D葡聚糖檢測對慢性阻塞性肺疾病并發肺部真菌感染的研究[J]. 中華醫院感染學雜志, 2012, 22(21):4690-4692.
7. 謝永平, 黎國梅, 溫杰冉, 等. 血漿(1,3)-β-D葡聚糖檢測在肺部真菌感染療效評價中的作用[J]. 國際檢驗醫學雜志, 2014, 35(5):517-518.
8. 中國侵襲性真菌感染工作組. 血液病/惡性腫瘤患者侵襲性真菌感染的診斷標準與治療原則(第三次修訂)[J]. 中華內科學雜志, 2010, 49(5):451-454.
9. 高蕾, 周新. (1, 3)-β-D 葡聚糖檢測在侵襲性真菌感染中的診斷意義[J]. 中國感染與化療雜志, 2008, 8(2):123-125.
10. Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis[J]. Mater Sociomed, 2013, 25(4):277-281.
11. 楊蘭萍, 胡皖玲, 余小龍. 血清降鈣素原指導兒童呼吸道感染抗生素應用的臨床意義[J]. 中國醫學工程, 2014, 22(1):40-42.
12. 常秀娟, 王春平, 曾珍, 等. 血清降鈣素原水平對發熱患者的診斷價值研究[J]. 人民軍醫, 2014, 57(3):281-282.
13. 張志華, 潘航, 沈紅石, 等. 降鈣素原和超敏C反應蛋白檢測在再生障礙性貧血合并肺部感染患者病原菌診斷中的意義[J]. 國際檢驗醫學雜志, 2013, 34(23):3146-3148.
14. 梅春霞, 劉娟, 徐智. APACHEⅡ評分和降鈣素原對肺部感染預后的預測作用[J]. 第三軍醫大學學報, 2014, 36(8):802-805.
15. Dou YH, Du JK, Liu HL, et al. The role of procalcitonin in the identification of invasive fungal infection-a systemic review and meta-analysis[J]. Diagn Microbiol Infect Dis, 2013, 76(4):464-469.

West China Medical Journal

Assessment of Diagnostic Value of Procalcitonin and/or (1,3)-β-D-glucan Test for Pulmonary Infection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content